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The Prevalence of Employed Nurses Identified or Enrolled in Substance Use Monitoring Programs

Monroe, Todd B.; Kenaga, Heidi; Dietrich, Mary S.; Carter, Michael A.; Cowan, Ronald L.

doi: 10.1097/NNR.0b013e31826ba3ca

Background: For over 100 years, nurses’ particular work conditions have been anecdotally associated with increases in substance abuse. Reasons include job-related stress and easy access to medications. Current research has suggested that prevalence of nurses with substance use problems is actually similar to, if not less than, that seen in the general population. However, given nurses’ proximity to critical patient care, the potential threat to public health, as well as the current shortage of practitioners and problems related to retention, the lack of research on the effectiveness of the two existing treatment protocols (disciplinary and alternative-to-discipline [ATD]) is a pressing issue of concern to the nursing profession.

Objectives: The aims of this study were to estimate the 1-year prevalence of employed nurses requiring an intervention for substance use problems in the United States and the 1-year prevalence of nurses enrolled in substance abuse monitoring programs and to compare the sum total of nurses identified in disciplinary and alternative programs with the general population.

Methods: This was a balanced stratified sampling design study. Measurements included the National Council of State Boards of Nursing 2010 Survey of Regulatory Boards Disciplinary Actions on Nurses, the 2009 annual reports of alternative programs, the 2008 National Sample Survey of Registered Nurses, and the 2009 National Survey on Drug Use and Health.

Results: The 2009 1-year prevalence of employed nurses identified with substance use problems in the United States and its territories was 17,085 or 0.51% of the employed nursing population. The 1-year prevalence of nurses newly enrolled in substance abuse monitoring programs in the United States and its territories was 12,060 or 0.36%. Although every National Council of State Boards of Nursing jurisdiction has a disciplinary monitoring program, only 73% (n = 43) of these jurisdictions have alternative programs. Despite this, on average, alternative programs had nearly 75% more new enrollees (9,715) when compared with disciplinary programs (2,345). The prevalence of nurses identified with a substance use problem requiring an intervention (and likely treatment) is lower than the prevalence of those who report receiving substance abuse treatment in the general population (0.51% vs. 1.0%).

Conclusions: The ATD programs potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more nurses with substance use problems, thereby initially removing more nurses with substance use problems from direct patient care.

Todd B. Monroe, PhD, is Research Associate, School of Nursing, Vanderbilt University, Nashville, Tennessee.

Heidi Kenaga, PhD, is Lecturer, Department of English, Wayne State University, Detroit, Michigan.

Mary S. Dietrich, PhD, is Associate Professor, School of Nursing, Vanderbilt University, and School of Medicine, Vanderbilt University, Nashville, Tennessee.

Michael A. Carter, DNSc, DNP, FAAN, is University Distinguished Professor, College of Nursing, The University of Tennessee Health Science Center, Memphis, Tennessee.

Ronald L. Cowan MD, PhD, is Associate Professor of Psychiatry, Psychology, and Radiology, School of Medicine, Vanderbilt Addiction Center, Vanderbilt Psychiatric Neuroimaging Program, Vanderbilt University, Nashville, Tennessee.

Accepted for publication June 28, 2012.

This paper was accepted under the editorship of Dr. Molly C. Dougherty.

The authors have no funding or conflicts of interest to disclose.

Corresponding author: Todd B. Monroe, PhD, Vanderbilt University School of Nursing, Vanderbilt University Institute of Imaging Science, 461 21st Ave. South, Nashville, TN 37209 (email:

© 2013 Lippincott Williams & Wilkins, Inc.